Association of cause-specific hospital admissions with high and low temperatures in Thailand: a nationwide time series study

Bo Wen; Wissanupong Kliengchuay; San Suwanmanee; Htoo Wai Aung; Narut Sahanavin; Weerayut Siriratruengsuk; Sawaeng Kawichai; Benjawan Tawatsupa; Rongbin Xu; Shanshan Li; Yuming Guo; Kraichat Tantrakarnapa

doi:10.1016/j.lanwpc.2024.101058

Association of cause-specific hospital admissions with high and low temperatures in Thailand: a nationwide time series study

Lancet Reg Health West Pac. 2024 Apr 4:46:101058. doi: 10.1016/j.lanwpc.2024.101058. eCollection 2024 May.

Authors

Affiliations

¹ Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
² Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
³ Environment, Health and Social Impact Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
⁴ Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
⁵ Faculty of Physical Education, Srinakharnwirot University, Nakhon Nayok, Thailand.
⁶ School of Health Science, Mae Fah Lhuang University, Chiang Rai, Thailand.
⁷ Research Institute of Health Science, Chiang Mai University, Chiang Rai, Thailand.
⁸ Department of Health, Ministry of Public Health, Nonthaburi, Thailand.

Abstract

Background: Non-optimum temperatures are associated with a considerable mortality burden. However, evidence of temperature with all-cause and cause-specific hospital admissions in tropical countries like Thailand is still limited.

Methods: Daily all-cause and cause-specific hospital admissions for outpatient and inpatient visits were collected from 77 provinces in Thailand from January 2013 to August 2019. A two-stage time-series approach was applied to assess the association between non-optimum temperatures and hospital admission. We first fitted the province-specific temperature-morbidity association and then obtained the national association in the second stage using a random-effects meta-analysis regression. The attributable fraction (AF) of hospital admissions with 95% empirical confidence interval (eCI) was calculated.

Findings: A total of 878,513,460 all-cause outpatient admissions and 32,616,600 all-cause inpatient admissions were included in this study. We observed a J-shaped relationship with the risk of hospital admissions increasing for both cold and hot temperatures. The overall AFs of all-cause hospital admissions due to non-optimum temperatures were 7.57% (95% eCI: 6.47%, 8.39%) for outpatient visits and 6.17% (95% eCI: 4.88%, 7.20%) for inpatient visits. Hot temperatures were responsible for most of the AFs of hospital admissions, with 6.71% (95% eCI: 5.80%, 7.41%) for outpatient visits and 4.50% (95% eCI: 3.62%, 5.19%) for inpatient visits. The burden of hospital admissions was greater in females and in children and adolescents (0-19 years). The fractions of hospital admissions attributable to non-optimum temperatures exhibited variation among disease categories and geographical areas.

Interpretation: The results indicate that low and high temperature has a significant impact on hospital admissions, especially among the females, and children and adolescents (0-19 years). The current investigation could provide evidence for policymakers to develop adaptation strategies and mitigate the adverse effects of climate change on public health in Thailand and other tropical countries.

Funding: National Research Council of Thailand (NRCT): E-Asia Joint Research Program: Climate change impact on natural and human systems (N33A650979).

Keywords: Cause-specific hospital admissions; High and low temperatures; Nationwide study.